Clinical Laboratories Reflexive Ordering
Clinical Laboratories Reflexive Ordering
The UCSF Medical Board recognizes that in some instances it is medically appropriate to perform reflex testing based on an initial laboratory result and in other instances reflex testing should be at the discretion of the ordering practitioner. In accordance with the UCSF Clinical Laboratory OIG Compliance Plan we approve the following reflex testing activity as proposed by the Laboratory Director. (Approved by UCSF EMB 8/25/2009)
| TEST ORDER | REFLEX ACTION | OPTION |
|---|---|---|
|
BLOOD BANK |
||
| Antibody Screen | If positive, testing initiated as required to identify the antibody (additional charges apply). | None, always reflexed |
| Direct Coombs Test | If positive, initiates testing to determine if reactivity is due to IgG or Complement on Red cells | None, always reflexed |
| Fetal Blood Screen | If positive, the sample is referred to hematology for Kleihauer-Betke testing to determine the extent of the bleed and to calculate the Rhogam dosage. The Kleihauer-Betke test is billed separately. | None, always reflexed |
|
CHEMISTRY |
||
| Hemoglobinopathy evaluation | If variant hemoglobin is detected by HPLC, hemoglobin electrophoresis is performed to characterize and classify the variant and billed for separately. | None, always reflexed |
|
CYTOGENETICS |
||
| Chromosome analysis | If an abnormality is detected the Director will determine the appropriate additional studies to be performed to characterize the abnormality. Additional studies may be separately billed. |
Lab may be asked to omit or inform the clinician prior to performing additional testing. |
|
HEMATOLOGY |
||
| Urinalysis | Samples submitted with orders for Urine macroscopic only (UA) that are positive for ascorbic acid (Vit. C) and negative for hemoglobin will be evaluated microscopically to rule out the presence of red cells. The UA will be canceled and a Urinalysis with microscopic examination will be ordered and billed (See additional information) | None, always reflexed |
| Urinalysis with Microscopy | Note this is a 'negative reflex': If the urine is negative for Protein, Hemoglobin, Leukocyte esterase and Ascorbic acid (Vit. C) the microscopic examination will be cancelled and credited | |
|
IMMUNOLOGY |
||
| Hep B Surface Ag |
Confirmatory test is run on all positives and separately billed |
None, always reflexed |
| HIV Antibody | If positive, confirmatory western blot is performed and billed for separately. | None, always reflexed |
| Lyme Disease Ab | Western Blot confirmation is automatically performed on all EIA positive tests. | None, always reflexed |
| RPR (Routine or Prenatal) | Yes, if positive a confirmatory test (TPAB) will be performed and billed for separately. | Requisition allows RPR to be ordered w/out reflex TP-AB |
|
MICROBIOLOGY |
||
| Bacterial Culture | If bacteria are present that are not considered normal flora, identification and susceptibility testing is performed as appropriate and separately billed. | Requisition allows for omission of full ID and susceptibility testing |
| Stool Culture | If E. coli O157 is identified the isolate is referred to SFPH to determine if strain produces toxin. There is no charge for this testing | None, always reflexed |
| Cryptococcal Antigen | If positive, specimen is titered at a separate charge. | None, always reflexed |
| First positive sputum smear for Acid-Fast-Bacilli (AFB) | Automatic reflex to State Public Health laboratory for Molecular probe testing for M. tuberculosis. | None, always reflexed |
|
Molecular Diagnostics |
||
| Cystic Fibrosis, PCR for common mutations | 5|7|9T Polymorphism test will be performed on all samples with R117H mutations and separately billed. | None, always reflexed |
| PML-RARA PCR, Qualitative | If a translocation is detected the quantitative assay (PMLQ) will be performed at an additional charge. | None, always reflexed |
|
NCPL |
||
| HIV, Rapid Antibody Screen | If positive a confirmatory Western Blot will be performed and separately billed. | None, always reflexed |
|
VIROLOGY |
||
| Clostridium difficile Antigen | Cell culture and neutralization for toxin will be performed if antigen is positive and billed separately. | None, always reflexed |
| Respiratory Virus DFA | If polyvalent screening is positive, further testing with specific stains is performed to identify the virus causing the reactivity. Additional stains are separately charged. | Requisition allows user to select panel or individual viral DFA's |